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FOR CITY VALIDATION <br />Reoeived by: <br />Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 ~h St ~ - R~m 1~2 ~ff NO: <br />SaI~, OR 97301 <br /> D~o: <br /> <br />24 Hr Inapection Linm 588-7904 <br />Ofl'~e~ $88-5147 8:00a.m.-4:30p.m. <br />FAX: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />I PERMIT~ AR~ NON-TRANSFIX. ABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> PA. CONTRACTOR INS'rALLATION ONLY <br /> <br />Contractor <br /> <br />Mailing Address <br /> <br />2B. FOR OWHI~. INSTALLATIONS <br />Prol~rty Own=r (ple~,pri~) <br /> <br />Job No. <br /> <br />Agcnt'a Signalu~: <br /> <br />Issued by: <br /> <br />4. FEB SCH~DULB (Complcta ~nd~ntee totalin A1 below) <br /> <br /> RBSIDEHTIAL~' COMMERCIAL [~ <br /> USE OF STRUCTURE: <br /> NEW m ALTERATION E] ADDITION E3 RELOCATION m <br /> GAS n or ELECTRIC ~1 <br /> No. X F~ =, Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 __ <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 -- <br />Suspended Heater $ 6.00 <br />Wail Heater $ 6.00 <br />Floor Mounted Heater $ 6.00 <br /> <br />HRAT pUlVIP <br />under 3 Ton $ 6.50 -- <br />3 Ton and up $1L00 <br /> <br />AIR COI~)ITIONER <br />under 3 Ton $ 6.50 <br />3 Tea and up $11.00 -- <br /> <br />EvaporativeCool~r $ 4.50 -- <br /> <br /> and Dry~ Vents $ 3.00 -- <br />Pir~ Damper ~}4~r..~.~,~ ~r c ~ ~.~ $ 3.00 <br /> <br />Furnace Duete (A~ter atioa/~xt ensign)~-/~n ~c $7.50 <br /> <br />ADDITIONAL APPLIAIqC~S <br /> ~ Gas Water Heatar <br />X Gas Log Lighter <br /> Gas Bad~lUe <br /> Other <br /> <br />$7.50 D~z''- <br />$7.50 -- <br />$7.50 <br />$7.50 -- <br /> <br />GAB PIPING SySFEM <br /> 1-4 out/cia (per outlet) <br /> 4 and up ou~ets (per outlet) <br /> <br />Appliance Vents not included iu <br /> ~ applia~co p=rmit <br /> <br />OTHER (as requited by Buil~ng Of EciaO <br />DWRLLINO PERMIT LABEL # of <br /> <br />$ 2.00 -- <br />$ .50 <br /> <br />3. PLANRI~VIi~W $1~CTION <br /> <br />Marion County does not require a plan review. <br />We .will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />5. NEBS <br />~A 1. Enter total of fees flora Sec.//4 <br /> A2. Add 5% surcharge (.Q$ x A 1) <br /> Subtotal <br /> <br /> B. <br /> <br /> C. Invoafiga~n Fee (if~qui~d) <br /> D. Roim~fion ~ ($2S.~) <br /> <br /> TOT~ ~O~ D~ <br /> R~eipt No. <br /> <br />$ <br />$ O <br /> <br /> <br />